Rupture of the right sinus of valsalva into the right ventricle: echocardiographic and angiographic imaging

We report a 16-year-old girl with acute rupture of the sinus of Valsalva. This case is unique in that the right coronary sinus of Valsalva ruptured into both the right and left ventricles, producing severe aortic insufficiency. The diagnosis was made with two-dimensional and color Doppler echocardiography which showed an abnormal jet flow from the aortic root into both ventricles. The diagnosis was confirmed by magnetic resonance imaging and aortic root angiography. Early diagnosis is important so that urgent surgical treatment can be taken.

Significance of QTc prolongation on ventricular arrhythmias in patients with left ventricular hypertrophy secondary to essential hypertension

The present study was designed to detect the arrhythmogenic effect of left ventricular hypertrophy, QTc prolongation and the relationship between the QTc duration and ventricular arrhythmias in patients with left ventricular hypertrophy secondary to essential hypertension. Sixty-eight hypertensive patients (51 male and 17 female, mean age 52+/-6 years) and 30 healthy normotensive subjects (22 male and eight female, mean age 49+/-6 years) were enrolled in the study. The frequency of ventricular arrhythmias was investigated with 24-h ambulatory electrocardiographic monitoring and grade 3 and 4 ventricular arrhythmias according to a modified Lown and Wolf classification were accepted as complex arrhythmias. The echocardiographic features of the patients were divided into five groups as follows: (1) normal left ventricular diameter and wall thickness, (2) concentric left ventricular hypertrophy, (3) asymmetric septal hypertrophy, (4) dilated left ventricle, (5) dilated and hypertrophic left ventricle. The frequency of complex ventricular ectopia and the QTc duration were estimated for each group and compared with Student's t-test. Left ventricular hypertrophy was detected in 38 of 68 patients (56%) with essential hypertension. In patients with left ventricular hypertrophy, the incidence of complex ventricular arrhythmias was two- and fivefold higher compared with patients without left ventricular hypertrophy and with controls, respectively. All of the patients with echocardiographic left ventricular dilatation had experienced complex ventricular arrhythmias. QTc duration correlated positively with left ventricular mass index and left ventricular internal diastolic dimension. The highest QTc intervals were detected in patients with left ventricular hypertrophy and complex arrhythmias. In patients with left ventricular hypertrophy, a QTc duration longer than 380 ms had a sensitivity of 74% and a specificity of 89% for detecting complex ventricular arrhythmias. It is concluded that patients with left ventricular hypertrophy have a higher incidence of complex ventricular arrhythmias and QTc prolongation in those patients can be a good marker for the increased risk of arrhythmias.

Impact of hemodialysis on comprehensive ventricular repolarization

Cardiac arrhythmia are one of the most important problems in haemodialysis patients. An important cause of the arrhythmias is inhomogenous myocardial repolarization. In this study, the ventricular repolarization parameters (QT, QTc, JT and JTc) and dispersions (d) of the parameters (QT-d, QTc-d, JT-d and JTc-d) were evaluated. Also were recorded the right-sided leads (RV3-6) and posterior leads (V7-9) in addition to the standard 12 lead ECG to assess comprehensive ventricular repolarization. The leads were divided in three groups: Group A (Standard ECG leads), Group B (Right-sided leads) and Group C (All of the leads). Among the above mentioned parameters, only JT and JTc intervals decreased significantly in all groups. There was no significant difference between the groups in evaluation of the parameters. It was concluded that in assessment of ventricular repolarization, the most important ECG intervals may be JT and JTc intervals, and the standard 12 lead ECG record is sufficient in evaluation of ventricular repolarization in hemodialysis patients.

Cardiac arrhythmias in patients on maintenance hemodialysis

Cardiac arrhythmias were evaluated in 20 patients (14 males and 6 females; 38.2 +/- 17.6 years) undergoing regular maintenance hemodialysis (HD) for chronic and renal failure (CRF) by Holter ECG monitoring a 24-hour period. Ventricular arrhythmias (VAs) were observed in 18 of 20 patients (90%). Sporadic VAs were recorded in 75% and frequent VAs in 15% of 20 patients. It was found that VAs were correlated with an increase in duration of CRF, but there was no relation with age, duration of HD, frequency of HD, body surface area, the levels of serum sodium, chloride creatinine, phosphorous (P), magnesium, free calcium (Ca), and free fatty acids, Ca x P, cardiothoracic ratio, ejection fraction, fractional shortening, interventricular septum thickness, left ventricular wall thickness, left ventricular end-diastolic dimension and left ventricular end-diastolic index. VAs recorded frequently during HD and for 4 hours after HD. In addition, sporadic supraventricular arrhythmias (SVAs) were observed in 16 patients (80%) and frequent SVAs were recorded in 2 patients (10%). It was concluded that cardiac arrhythmias frequently developed in patients with CRF receiving HD, VAs significantly increase during HD and for 4 h after HD and frequency of VAs may be correlated with duration of CRF and the use of acetate as a buffer in the dialysate.

Echocardiography and magnetic resonance imaging of sinus of Valsalva aneurysm with rupture into the ventricle

A 53 year-old man with rupture of sinus of Valsalva aneurysm into the right ventricle diagnosed by two dimensional echocardiography (2DE), magnetic resonance imaging (MRI), and catheterisation study is reported in this paper. Despite the fact that its incidence is low, early diagnosis is very important in this illness because of the possibility of complete cure with surgery. In this study it was shown that MRI as well as 2DE is an excellent diagnostic method for this illness. The diagnosis was also confirmed with surgery in this patient.

Significance of QT dispersion on ventricular arrhythmias in mitral valve prolapse

The present study was designed to detect the arrhythmogenic effect of mitral valve prolapse, and the relationship between QT, QT dispersion and ventricular arrhythmias in subjects with mitral valve prolapse. Sixty-four mitral valve prolapse subjects (24 men and 40 women, mean age 27 +/- 6), and 80 healthy control subjects (32 men and 48 women, mean age 28 +/- 7) were studied. The frequency of ventricular arrhythmias by means of 24-h ambulatory electrocardiographic (ECG) monitoring was investigated. Grade > or = 3 ventricular arrhythmias according to modified Lown and Wolf classification were accepted as complex arrhythmias. The QT intervals were measured from the beginning of depolarization of the QRS complex to the end of the T wave. Using the Bazett formula, QT interval was corrected (QTc) for heart rate. QT dispersion was calculated as the difference between the maximum and minimum QT intervals on any of 12 leads. Premature ventricular complexes seemed to develop in 56 of 64 (87.5%) subjects with mitral valve prolapse. Thirty-eight of the mitral valve prolapse subjects had complex premature ventricular complexes during 24-h ECG and the prevalence of premature ventricular complexes was found to be higher than the control subjects (P < 0.001). We found QT and QTc intervals of 388 +/- 27 and 406 +/- 33 ms in mitral valve prolapse subjects, these values in control subjects were 382 +/- 18 and 402 +/- 11 ms respectively (P > 0.05). QT dispersion and QTc dispersion intervals were 71 +/- 17 and 78 +/- 19 ms in mitral valve prolapse subjects and these values were 43 +/- 16 and 52 +/- 22 ms in control subjects, respectively (P < 0.001). No correlation was found between complex premature ventricular complexes and QT, but there was a correlation between complex premature ventricular complexes and QT dispersion in the mitral valve prolapse subjects. It was concluded that QT dispersion might be a useful marker of cardiovascular morbidity and mortality due to complex ventricular arrhythmias.

The diagnostic and prognostic value of adenosine deaminase in tuberculous pericarditis

Because of the difficulty in isolating the causative organism, pericardial tuberculosis is rarely diagnosed. Adenosine deaminase activity measured in the pericardial fluid of 108 patients was initially of undetermined origin. Subsequently, we classified five sources: (1) tuberculosis (20 cases); (2) idiopathy (82 cases); (3) neoplasia (three cases); (4) purulent bacterial infection (two cases); and (5) radiotherapy (one case). The highest mean adenosine deaminase value (126 +/- 16.68 U.l(-1) was found in group 1; other values were 29.4 +/- 8.9, 27 +/- 7.21, 29.5 +/- 13.4, 26 U.l(-1) in the idiopathy, neoplasia, purulent bacterial infection and radiotherapy groups, respectively. there was a statistically significant difference between group 1 and the other groups (P less than 0.001), indicating that the adenosine deaminase value has 100% sensitivity and 91% specificity. In addition, there was a positive correlation between high adenosine deaminase values and the development of constrictive pericarditis. In this study, two patients required pericardectomy. Therefore, the adenosine deaminase value is a significant prognostic indicator for the development of constrictive pericarditis in tuberculous pericarditis.

Evaluation of lipoprotein (a) [Lp (a)] as a risk factor for coronary artery disease in the Turkish population

OBJECTIVE

Lipoprotein (a) [Lp (a)] is an atherogenic particle that structurally resembles a low-density lipoprotein (LDL) particle but contains a molecule of apolipoprotein (a) attached to apolipoprotein B-100 by a disulfide bond. Because of the fact that elevated plasma levels of Lp (a) have been shown to be an independent risk factor for coronary artery disease (CAD), we determined plasma Lp(a) levels in CAD for Turkish population, and compared them with previous findings of some developed countries.

RESULTS

The mean plasma Lp (a) levels in CAD group (mean +/- SD; 0.41 +/- 0.21, g/L) was found approximately twofold higher than that of the control group (0.21 +/- 0.17 g/L). Also, it was found to be higher than the mean levels of CAD group in the other populations described in previous reports. But CAD prevalence in the Turkish population is lower than in those of developed countries, especially the United States.

CONCLUSIONS

We concluded that the interaction between plasma Lp (a) levels and many other factors such as face and heredity affecting development of CAD may show different effects for development of CAD in each of those populations separately.

Doppler evaluation of left ventricular diastolic filling in Behçet's disease

Although cardiac involvement such as pericarditis, myocarditis, coronary arteritis and valvular disease in Behçet's disease occurs, few studies have assessed left ventricular diastolic function. This study assesses the prevalence of both systolic and diastolic left ventricular dysfunction in patients with Behçet's disease who have no clinical cardiac manifestations. Twenty-two patients (12 women and 10 men, mean age 34 +/- 2.4 years) underwent full clinical examination, electrocardiography, M-mode, two-dimensional, and Doppler echocardiography. The mean disease duration was 5 +/- 4.7 years (range, 1 month-16 years). As age and sex-matched control group of 20 healthy subjects was also studied. Prolonged isovolumic relaxation time, prolonged deceleration time, reversal of the early and late peak transmitral diastolic flow velocities, late peak transmitral diastolic flow velocities (E/A ratio) and increased atrial filling fraction were noted in five patients. It is concluded that left ventricular dysfunction occurs frequently in patients with Behçet's disease and Doppler echocardiography may be valuable in detecting diastolic filling abnormalities as an early sign of cardiac involvement.

The Jervell and Lange-Nielsen syndrome

The association of prolongation of the QT interval with recurrent attacks of syncope, sudden death, and malignant ventricular arrhythmias is known as the long QT syndrome. The syndrome may be familial with or without congenital deafness, or idiopatic. The syndrome with deafness (Jervell and Lange-Nielsen syndrome) is inherited through an autosomal recessive mechanism. In this study, we attempted to identify patients with the Jervell Lange-Nielsen syndrome amongst 154 deaf mute school children. Two patients had a corrected QT interval of 0.52 and congenital sensorineural hearing loss with the other electrocardiographic changes characteristic of the syndrome, such as inverted or bifid T wave. There was no evidence of electrocardiographic (ECG) abnormality in family members, except only one case of parental deafness. This is the first and preliminary report that analyzed the incidence of the Jervell and Lange-Nielsen syndrome amongst 154 deaf mute school children in Turkey. Our study was conducted to identify patients with this syndrome amongst children of another deaf mute school in Turkey.

Prevalence and risk factors of varicose veins in an elderly population

The prevalence of and risk factors for varicose veins (VV) were studied in elderly persons over 60 years of age who had visited the Tonya and Farabi Hospitals in Trabzon, a city in northeastern Turkey. VV were defined as dilated, tortuous and elongated veins of the lower extremities and were classified into four types. The total prevalence of VV was 36.7% (14.6% in males and 22.1% in females). Segment type varices were observed in 16.5%, saphenous type in 5.6%, reticular type in 4.7%, web type in 2.3%, and combined types in 7.5%. The prevalence of VV increased with age and was greater among those with a family history of the condition in 154 of 312 patients with VV (49.4%). Other factors, such as congestive heart failure, angina pectoris, hypertension, cigarette smoking, diabetes mellitus, height, weight, obesity, or hyperlipidemia, were not found to be associated with the prevalence of VV. However, the factors of age, work posture and childbirth did show an association with prevalence, as reported by others.